Hi Dr. I know there are alot of questions about when to start taking meds. I am newly infected infact only a week ago I found out my status so I am trying to be as informed as possible as to what my options may be. My question is lets say my cd4 count is at 450 and I start taking meds while my count is at 450. Does that preserve the cd4 count that I already have? -vs- taking meds lets say when my cd4 count reaches 350. If I wait till my cd4 count reaches 350 will that count have a chance to go back up to 450. If not then is it in your opinion to take them as early as possible even if your count is at 500 or more to preserve what you already have. I think having a count as high as possible improves your chances of maintaining a healthier immune system of course provided that you adhere to your drug regiment as prescribed. Personally I feel that if I wait till lets say I have a cd4 count of 350 and my levels will not peak as high as the 450 again Then why not always start at a higher cd4 count to protect and preserve your counts The more you have the better off your immune system is. Am I correct in thinking that. Thank you for your time in answering my question.

Hello,

The general rule for all infectious diseases is that once you've made the diagnosis that someone is infected, you should begin therapy to treat or hopefully cure the infection if treatment is available. So why is HIV/AIDS different? As I hope everyone knows, we don't have a cure for HIV and a potential cure is not even on the distant horizon. However, we do certainly have potent anti-HIV drugs called antiretrovirals. These medications are grouped into several different classes based on their mechanism of action, such as nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors, fusion inhibitors, CCR5 antagonists, etc. The reason we don't immediately recommend antiretroviral therapy as soon as someone realizes he is infected has to do with balancing the benefits of these life-sustaining but non-curative drugs against issues of tolerance, long- and short-term side effects, development of drug resistance, adherence issues and cost. The "when to start" treatment pendulum has swung to and fro over the years as we learned more about HIV pathogenesis and natural history as well as discovered multiple undesirable and unanticipated negative consequences of taking antiretroviral therapy.

Presently, the treatment pendulum is definitely swinging toward earlier treatment intervention based on the availability of newer, novel, less toxic, better tolerated drugs and additional knowledge of HIV-related immune damage early in the course of the disease process. The treatment guidelines have recently changed from recommending antiretroviral intervention when CD4 counts fall to the 200-250 range to recommending treatment around 350. Many HIV specialists, including yours truly, believe there is growing evidence for starting even earlier to preserve immune function and decrease immune activation. You can learn much more about all these issues by perusing the wealth of information on this site, in its archives and at its related links. You should also discuss this issue and your concerns with your HIV specialist. He will be able to give you a much more detailed response based on your specific case and laboratory results.

Good luck! Be well.

Dr. Bob